A family pensioner cannot be denied medical reimbursement based on age criteria applicable to dependents, as the reimbursement rules misapplied in the petitioner's case lead to arbitrary denial of entitled benefits.

JUDGMENT :

Pankaj Purohit, J.

By means of the present writ petition filed under Article 226 of the Constitution of India, the petitioner has challenged the communication/order dated 03.02.2024 issued by respondent no. 2, whereby the claim of the petitioner for reimbursement of medical expenses has been declined on the ground that the petitioner was above 25 years of age at the time of treatment and, therefore, not entitled to the benefit under the applicable Government Orders. The petitioner further seeks a direction to the respondents to reimburse the medical expenses incurred by her.

2. The facts, in brief, as borne out from the record are that the petitioner, namely Karishma Bhatt, is the daughter of a deceased government employee. The parents of the petitioner passed away a few years ago, and after the death of her mother in the year 2020, the petitioner was granted family pension. It is the case of the petitioner that pursuant to the introduction of the State Government Health Scheme, the benefit of the scheme was extended to pensioners as well as family pensioners. The petitioner, being a recipient of family pension, was issued a Golden Card under the said scheme, and contributions towards the scheme were regularly deducted from her pension. In the year 2021, the petitioner met with an accident and sustained serious injuries, for which she was admitted to the All India Institute of Medical Sciences (AIIMS), New Delhi. The petitioner has placed on record the Essentiality Certificate issued by AIIMS in support of her treatment. The petitioner submitted claims for reimbursement of medical expenses. Two bills amounting to Rs. 5,130/- and Rs. 20,000/- were reimbursed by the authorities. However, a major bill amounting to Rs. 4,29,561/- was not reimbursed. Upon inquiry, the petitioner was informed through a communication dated 03.02.2024 issued by respondent no. 2 that since the petitioner was more than 25 years of age at the time of treatment, she was not entitled to medical reimbursement, in view of Government Orders dated 04.05.2020 and 25.11.2021. Aggrieved by the said communication and denial of reimbursement, the petitioner has approached this Court by filing the present writ petition.

3. Learned counsel for the petitioner submits that the impugned action of the respondents is wholly arbitrary, illegal and based on a complete misinterpretation of the applicable Government Orders. It is argued that the petitioner is not claiming reimbursement as a “dependent” of a government servant, but as a family pensioner in her own independent right. Therefore, the Government Orders relied upon by the respondents, which are applicable to dependents of government employees, have no application in the present case. Learned counsel further submits that the petitioner has been granted family pension after the death of her mother, and under the State Government Health Scheme, she has been issued a Golden Card. It is further emphasized that regular deductions towards the scheme are being made from the petitioner’s pension, which clearly establishes her entitlement to the benefits of the scheme.

4. It is contended by the learned counsel for the petitioner that once the State has accepted contributions from the petitioner and extended the scheme to her, it cannot subsequently deny the benefit on untenable grounds. Such action is hit by the doctrine of legitimate expectation and is violative of Article 14 of the Constitution of India. It is further argued that the petitioner had undergone treatment in AIIMS, New Delhi, which is a premier government institution, and the Essentiality